Healthcare Provider Details

I. General information

NPI: 1336412915
Provider Name (Legal Business Name): FERNANDO W MARTINEZ JR. MA, BCBA, LBA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2012
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11303 ELMCROFT AVE
NORWALK CA
90650-7610
US

IV. Provider business mailing address

11303 ELMCROFT AVE
NORWALK CA
90650-7610
US

V. Phone/Fax

Practice location:
  • Phone: 562-239-9902
  • Fax: 562-376-3646
Mailing address:
  • Phone: 562-239-9902
  • Fax: 562-376-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-18-32500
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberBEH-001338
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: